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Rempakos A, Kostantinis S, Simsek B, Karacsonyi J, Alexandrou M, Choi JW, Poommipanit P, Khatri JJ, Young L, Davies R, Benton S, Jaffer FA, Chandwaney R, Azzalini L, Alaswad K, Jefferson B, Frizzell J, Abi-Rafeh N, Elguindy A, Goktekin O, Rangan BV, Mastrodemos OC, Allana SS, Sandoval Y, Burke NM, Brilakis ES, Gorgulu S. Impact of preprocedural anemia on in-hospital and follow-up outcomes of chronic total occlusion percutaneous coronary intervention. Catheter Cardiovasc Interv 2023; 102:857-863. [PMID: 37681964 DOI: 10.1002/ccd.30810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/17/2023] [Accepted: 08/15/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND The impact of preprocedural anemia on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. METHODS We examined the clinical and angiographic characteristics and procedural outcomes of 8633 CTO PCIs performed at 39 US and non-US centers between 2012 and 2023. Anemia was defined as a hemoglobin level of <13 g/dL in men and <12 g/dL in women. RESULTS Anemia was present in 1652 (19%) patients undergoing CTO PCI. Anemic patients had a higher incidence of comorbidities, such as diabetes mellitus, hypertension, dyslipidemia, heart failure, cerebrovascular disease, and peripheral arterial disease. CTOs in anemic patients were more likely to have complex angiographic characteristics, including smaller diameter, longer length, moderate to severe calcification, and moderate to severe proximal tortuosity. Anemic patients required longer procedure (119 vs. 107 min; p < 0.001) and fluoroscopy (45 vs. 40 min; p < 0.001) times but received similar contrast volumes. Technical success was similar between the two groups. In-hospital major adverse cardiac events (MACE) rates were higher in patients with anemia; however, this association was no longer significant after adjusting for confounding factors. Baseline anemia was independently associated with follow-up MACE (adjusted hazard ratio [HR]: 1.63; 95% confidence interval [CI]: 1.07-2.49; p = 0.023) and all-cause mortality (adjusted HR: 3.03; 95% CI: 1.41-6.49; p = 0.004). CONCLUSIONS Preprocedural anemia is associated with more comorbidities, higher lesion complexity, longer procedure times, and higher follow-up MACE and mortality after CTO PCI.
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Affiliation(s)
- Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Michaella Alexandrou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - James W Choi
- Texas Health Presbyterian Hospital, Dallas, Texas, USA
| | - Paul Poommipanit
- University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | | | | | | | | | - Lorenzo Azzalini
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | | | - Brian Jefferson
- Tristar Centennial Medical Center, Nashville, Tennessee, USA
| | | | | | - Ahmed Elguindy
- Aswan Heart Center, Magdi Yacoub Foundation, Cairo, Egypt
| | | | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Olga C Mastrodemos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Salman S Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Nicholas M Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
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Yang Y, Huang Y. Association between serum hemoglobin and major cardiovascular adverse event in Chinese patients with ST-segment elevation myocardial infarction after percutaneous coronary intervention. J Clin Lab Anal 2021; 36:e24126. [PMID: 34894008 PMCID: PMC8761445 DOI: 10.1002/jcla.24126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 11/07/2022] Open
Abstract
Background ST‐segment elevation myocardial infarction (STEMI) is a common clinical acute and severe disease, and it is of great significance to evaluate the prognosis of these patients. Hemoglobin levels are associated with a variety of diseases, but studies on Chinese patients with STEMI after percutaneous coronary intervention (PCI) have not been sufficient. Methods This was a secondary analysis based on a prospective cohort study of patients undergoing PCI in Taizhou, Zhejiang, China. We performed multivariable logistic regression to explore the association between the serum hemoglobin and the incidence of major cardiovascular adverse event (MACE) in patients after PCI. We also used a generalized additive model and smooth curve fitting to explain the nonlinear relationship after adjusting the potential confounders. Finally, the heterogeneity among specific groups was examined by subgroup analysis. Results Of all 462 patients enrolled in this study, 118 (25.54%) developed MACE. There was a negative correlation between serum hemoglobin and MACE in all three models (hazard ratio [HR] 0.82, 95% confidence interval [CI 0.72, 0.93], HR 0.86, 95% CI [0.76,0.98], and HR 0.87, 95% CI [0.74,0.98], respectively). In the subgroup analysis, the negative correlation existed between the patients who had myocardial infarction (MI) history (p for interaction = 0.0059) after adjusting covariates. However, no significant differences were found between age and sex groups (p for interaction = 0.1381, 0.4103, respectively). Conclusion Our results indicated that patients who received PCI with low preoperative hemoglobin were more likely to develop MACE, especially if they have already had a history of MI.
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Affiliation(s)
- Yulu Yang
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 JieFang Avenue, Wuhan, Hubei, 430022, China
| | - Yun Huang
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 JieFang Avenue, Wuhan, Hubei, 430022, China
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Zhao Y, Li J, Ma S, Jiang Z, Li Z, Wang X, Han Y, Li Y. Impact of extended dual antiplatelet therapy on long-term prognosis in patients with acute coronary syndrome complicated with anemia: A sub-analysis of the real-world OPT-CAD study. Catheter Cardiovasc Interv 2021; 98:E235-E242. [PMID: 33817946 DOI: 10.1002/ccd.29676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/08/2021] [Accepted: 03/16/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To evaluate the impact of extended dual antiplatelet therapy (DAPT) beyond 12 months on long-term prognosis in acute coronary syndrome (ACS) patients complicated with anemia undergoing percutaneous coronary intervention (PCI). BACKGROUND Anemia is frequent among ACS patients and is associated with increased risk of adverse clinical outcomes. METHODS A total of 6,953 patients were enrolled from the Optimal anti Platelet Therapy for Chinese patients with Coronary Artery Disease (OPT-CAD) study. A landmark analysis comparing extended DAPT versus single antiplatelet therapy (SAPT) at 12-24 months were performed in anemia patients without premature discontinuation of DAPT before 9 months and major clinical adverse events within 12 months. The primary outcome was major adverse cardiovascular and cerebrovascular events (MACCE), defined as a composite of all-cause death, myocardial infarction, and stroke. RESULTS Patients with anemia (n = 1,728) had higher rates of MACCE, all-cause mortality, and BARC type 2, 3, 5 bleeding (p < .05) compared to those without anemia (n = 5,225). Anemia patients received extended DAPT (n = 1,010) were associated with a lower risk of stroke (0.3% vs. 1.8%; HR, 0.14; 95% CI, 0.03-0.71; p = .018) compared to those received SAPT (n = 342). The rates of MACCE and all revascularization were lower in patients with extended DAPT, but the differences were not statistically significant. Risk of all-cause mortality and bleeding were comparable between the two groups. CONCLUSIONS Extended DAPT beyond 12 months may reduce the incidence of stroke without increasing the risk of bleeding in anemic ACS patients who tolerate 12-month DAPT.
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Affiliation(s)
- Yu Zhao
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
- The Graduate School, Dalian Medical University, Dalian, China
| | - Jing Li
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Sicong Ma
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Zaixin Jiang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Zhiguo Li
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Xiaozeng Wang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yaling Han
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yi Li
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
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Han XJ, Li JQ, Khannanova Z, Li Y. Optimal management of coronary artery disease in cancer patients. Chronic Dis Transl Med 2019; 5:221-233. [PMID: 32055781 PMCID: PMC7005131 DOI: 10.1016/j.cdtm.2019.12.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Indexed: 01/01/2023] Open
Abstract
Owing to early diagnosis and rapid development of treatments for cancers, the five-year survival rate of all cancer types has markedly improved worldwide. Over time, however, there has been an increase in the number of cancer patients who develop coronary artery disease (CAD) due to different causes. First, many risk factors are shared between cancer and CAD. Second, inflammation and oxidative stress are common underlying pathogeneses in both disorders. Lastly, cancer therapy can result in endothelial injury, coronary artery spasm, and coagulation, thereby increasing the risk of CAD. As more cancer patients are being diagnosed with CAD, specialized cardiac care should be established to minimize the cardiovascular mortality of cancer survivors.
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Affiliation(s)
- Xue-Jie Han
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, Heilongjiang 150001, China
| | - Jian-Qiang Li
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, Heilongjiang 150001, China
| | - Zulfiia Khannanova
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, Heilongjiang 150001, China
- Bashkir State Medical University, Ufa, Republic Bashkortostan, Russia
| | - Yue Li
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, Heilongjiang 150001, China
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Oren O, Herrmann J. Arterial events in cancer patients-the case of acute coronary thrombosis. J Thorac Dis 2018; 10:S4367-S4385. [PMID: 30701104 PMCID: PMC6328398 DOI: 10.21037/jtd.2018.12.79] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 12/14/2018] [Indexed: 12/21/2022]
Abstract
Patients with cancer are at high risk for both venous and arterial thrombotic complications. A variety of factors account for the greater thrombotic risk, including the underlying malignancy and numerous cancer-directed therapies. The occurrence of an acute thrombotic event in patients with cancer is associated with substantial morbidity and mortality. Acute coronary syndrome (ACS) represents a particularly important cardiovascular complication in cancer patients. With cardio-vascular risk factors becoming more prevalent in an aging cancer population that is surviving longer, questions pertaining to the appropriate management of vascular toxicity are likely to assume even greater value in the coming years. In this article, we review the current understanding of ACS in patients with cancer. The predisposition to thrombosis in a malignant host and the cancer treatments most commonly associated with vascular toxicity are reviewed. Risk prediction and management strategies are discussed, and discrepancies in the clinical evidence are highlighted.
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Affiliation(s)
- Ohad Oren
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Joerg Herrmann
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
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